Cigarette smoking is the most common preventable cause of cancer, and smoking cessation reduces the risk of cancer and other diseases at any age. Patients who smoke are more likely to quit if their physicians counsel them. However, physicians identify only about half of current smokers, advise less than half, and assist and arrange follow-up with an even smaller proportion. The candidate, a pulmonary physician at the University of Vermont, has redirected his career to address this challenge of improving implementation of the evidence-based guidelines for tobacco use and dependence treatment. The plan includes additional didactic course work in research methodologies and quality improvement methods studies that will provide the foundation for a proposal for a randomized controlled trial of computer that supplements the candidate's recent public health training. The candidate will also conduct preliminary mediated clinical decision support systems (CDSSs). Prior research suggests that improving implementation of these guidelines should focus on developing systems that facilitate the physician's performance of the guideline elements. CDSSs can be designed to indicate the patient's smoking status, to provide detailed guideline recommendations, to link a patient with community resources, and to produce patient-specific handouts. Despite their potential, CDSSs are not widely used by physicians or by the majority of health care organizations. Some of these systems have been cumbersome to use, or have been difficult to integrate into the physician's workflow. Health service researchers recommend that these systems be designed in conjunction with physicians and their health care organizations. This project uses surveys to define the needs of physicians, their familiarity with information technology, and their health care environment. CDSSs for smoking cessation would be designed using this information and then adapted with further feedback from physicians and clinic administrators through focus groups and a pilot test of the adapted CDSS. The project will prepare the candidate to evaluate CDSSs in a randomized controlled clinical trial that tests the hypothesis that these systems improve implementation of the guidelines for treating tobacco use and dependence, and increase quit attempts by patients who smoke. It will also prepare the candidate to design and evaluate other methods of increasing implementation of evidence-based guidelines. The candidate's work will be under the sponsorship of Dr. Brian Flynn of the Office of Health Promotion Research at the University of Vermont.